“Facing deficits, states get out sharper knives.” That ominous headline appeared on the top of page 1 in Monday's New York Times. The article noted that most states “are scrambling to find ways to get through the rest of the year.” That's a challenge more of us now find ourselves facing. But let's hope that budget cutters at the state level don't get too carried away. The reality is that providers are already being shortchanged by states. Medicaid alone underpays operators by more than $4 billion, according to a study commissioned by the American Health Care Association. It's no secret that these are challenging times times. But that's hardly an excuse for states to abdicate their responsibilities to our nation's elderly – or to the providers increasingly tasked with delivering the care they need.